Pandemic Stress Likely Compounded by Seasonal Affective Disorder

COVID-19 and The Road Ahead

From Boosters & Breakthroughs to Vaccines & Variants: Where Do We Go From Here?

The following reflects an 8/24/2021 discussion; please check the CDC website for real-time updates as the situation continues to evolve.

Their answers may not land lightly, but epidemiologist Jodie Guest, PhD, and drug development expert Michael Kinch, PhD, have been immersed in examining COVID-19 since its first stirrings in early 2020. They share an informed look at the road ahead for us all.

State of Concern

Noting more than 39 million COVID-19 cases nationwide, (as of 9/2/21) Guest projects this will continue to rise rapidly and eclipse one million a week. While “hot spots” for outbreaks clearly correspond to the country’s most lightly vaccinated locales, the impact of the delta variant is being felt in virtually every state. “There’s almost nowhere you can go in the U.S. that you don’t need to be masked indoors, even if vaccinated,” she says. The progressive increase in vaccinated patients with COVID-19 in European hospitals is also troubling, says Kinch, a potential harbinger of what is to come for the U.S.

However, what’s driving the surge is not cases among the vaccinated, known as “breakthroughs.” It’s a term Guest would like to eliminate permanently, given its negative connotation regarding vaccine efficacy. “These type of infections are still rare. More than 90% of those hospitalized with COVID-19 are unvaccinated.” She points out that while viral loads in patients with COVID-19 are the same for vaccinated and unvaccinated patients in the first few days of illness, they drop much faster and further in the vaccinated.

The vaccine, contends Kinch, was never intended to eliminate all possibility of getting COVID-19. “It’s not a suit of armor,” he says, “because no vaccine ever provides 100% protection. But we know they work incredibly well to prevent you from getting very sick or dying.”

The FDA’s recent approval of the Pfizer mRNA vaccine, with Moderna approval expected to follow soon, is pivotal, says Guest, in helping launch vaccination requirements at businesses, schools and other locations. “Don’t underestimate the importance of this approval in providing support for mandates that will protect all of us,” she says. “Recognize that in the entire history of vaccines, there has never been a set more studied than the ones we have now.”
Adds Kinch, “With the enormous amount of data gathered on the vaccines’ efficacy and safety, those who think of themselves as vaccine hesitant may more accurately be described as vaccine resistant.”

Third Doses and Boosters

The recent approval of a third dose of Pfizer or Moderna for immunosuppressed patients who didn’t build sufficient immunity from the first two doses applies to just 3% of the adult population. For everyone else (with the exception of pregnant women), a booster shot six to eight months after the initial series is being considered for approval.

“Right now, that’s how long we believe we can go without significantly diminished immunity,” says Guest. Antibody tests are not proven to be an accurate measure of protection from COVID-19, says Kinch, because the antibody levels vary by individual.

If you received Pfizer or Moderna initially, choose the same for a booster. Notes Kinch: “There’s no difference between these two vaccines—one is not better than the other.” In fact, some studies show no impact on efficacy from switching brands, he says; Johnson & Johnson data is yet to come.

And where does the flu shot fit in this fall? Absolutely essential, both agree, with the only caution that a two-week separation between the two vaccines may be recommended by some healthcare providers to avoid triggering a hyperactive immune response.

Protecting our Children

The best way to keep youngsters under 12 safe is ensuring that everyone around them is vaccinated, says Guest.
“Teachers, caregivers, babysitters and others should be vaccinated, or fully masked whenever they’re with children,” she advises. A different dose is being tested for 5- to 12-year-olds, with approval possible later this year.

The Next Wave of Variants?

While not identified by the Centers for Disease Control (CDC) as a “high concern,” Kinch admits that the lambda variant worries him primarily because not enough is known about its ability to resist vaccines. “One view is that the COVID-19 spike protein can only mutate to a certain point, and if that’s true, lambda could be the end of the virus. The other view is that we don’t know if it stopped mutating,” he says.
“We’re not defenseless, though,” counters Guest, “because we can keep it from getting here by having COVID-19 not circulating in communities. Greater numbers of vaccinated people will prevent us from getting whatever variant might follow delta.”

Stay Safe and Well

One of last year’s most popular signoff lines takes on new resonance as our experts advise on what that now means for the vaccinated in fall 2021.

Mask Up, Indoors and Out.

Masks are increasingly needed outside in crowded areas. Indoors, remember that while a soft, comfortable cloth mask protects others from you, if you need extra protection in certain settings, use a KN95 or N95 mask.

Pass on Indoor Dining, Movies, Concerts and Sporting Events.

Also reconsider full-capacity outdoor events with no masking/distancing/vaccine requirements. (As an alternative, order take-out and support virtual events offered by local venues). And avoid getting together in person with those who are not vaccinated.

Reach out to Every Unvaccinated Person you Know.

“The best action we can take is to keep encouraging every unvaccinated person we know to get the shot, now,” advises Guest. “We’re all in the race against variants and need to work together to defeat them as quickly as possible.” Adds Kinch, “It’s unfortunate that the motivations behind much of the messaging has messed up the message itself. Be completely honest about what is known and not known about the vaccine.”

The Swiss Cheese Respiratory Pandemic Defense.

“Layering prevention messages is crucial because the delta variant has made the holes in the Swiss cheese slice of the vaccine just a bit bigger,” says Guest. “Now masks are more crucial than ever before.”

Dr. Jodie Guest is professor and vice chair of the Department of Epidemiology, Emory University, Atlanta, and award-winning leader of Emory’s Outbreak Response Team for COVID-19.

Dr. Michael Kinch is associate vice chancellor and founder/director of the Center for Research Innovation in Biotechnology and the Center for Drug Discovery at Washington University, St. Louis.

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New Lung Cancer Screening Recommendations

Spotlighting Both Challenges and Progress

This winter the U.S. Preventive Services Task Force (USPSTF) released its new Lung Cancer screening recommendations, lowering both the starting age and pack-year criteria. Previously, low-dose computed tomography screening was advised for adults age 55 to 80 years with a 30 pack-year history of smoking who are current smokers or have quit within the past 15 years; now the USPSTF recommends extending the screening to adults starting at age 50 who have a 20 pack-year smoking history.

For most, the announcement may have gone under the radar due to the intense focus on the COVID-19 vaccine rollout in early 2021. But as the first change in lung cancer screening eligibility criteria since 2013, its significance was quickly recognized and is still being broadly debated across the medical community.

Notably, previous recommendations missed female patients who tended to be lighter smokers than men, and despite Black smokers’ higher risk of developing lung cancer, included only 17% of Black people who smoke compared to 31% of White smokers. The question is, by doubling the number of people eligible for screening, do the guidelines indicate a significant shift that will improve gender and racial disparities in testing and outcomes, or are they simply a small, overdue step in the right direction?

“It’s excellent news because expanded screening eligibility can reduce lung cancer mortality and may reduce all-cause mortality,” acknowledges Ella Kazerooni, MD, professor of radiology and internal medicine at the University of Michigan Medical School, who’s devoted much of her career to creating lung cancer survivors through her work as chair of the National Lung Cancer Roundtable.

The downside: “This may also cause false-positive results, leading to unnecessary tests and invasive procedures, because we’re still not incorporating other known risk factors. These encompass more than just smoking, but include air pollution, exposure to radon and other carcinogens, family history and social determinants of health,” says Dr. Kazerooni.

In March 2021, the American Academy of Family Physicians (AAFP) weighed in with support for the measure while also noting the need for additional research to determine potential harms from annual screening.

“More studies are needed to achieve our goal of increasing survivorship and lowering mortality without enhancing risk along the way,” agrees Dr. Kazerooni. “Compared to cardiac disease, research for lung cancer screening and risk assessment is relatively new and evolving. Tools, like an individualized lung cancer risk calculator, will take time to develop because of the complexity of the disease.”

Lung cancer survivor Jill Feldman views the new recommendations with the same unflinching honesty that’s fueled her remarkable 20-year crusade for others with the disease. She is the former president of LUNGevity and a founding member of the EGFR Resisters, both leading nonprofit patient support and advocacy organizations.

“We took too long to get here,” she says, “and it’s still not being viewed with a nearly wide enough lens. By focusing solely on age and smoking habits, we’re not considering the critical intersection of environmental factors and personal and family history that impact an individual’s risk of lung cancer.”
Having lost two grandparents, an aunt and both her parents to lung cancer before being diagnosed in 2009 with non-small cell lung cancer at age 39, Jill is painfully aware of the barriers that still surround screening and treatment.

“Despite its prevalence, lung cancer carries a real stigma,” says Jill. “The unintended consequence of successfully educating the public about the heightened risk of lung cancer among people who smoke, is that it’s considered preventable, making people reluctant to seek screening, and if diagnosed, ashamed to admit they have it.”

“It’s a significant problem that impacts people along the entire cancer care continuum,” says Dr. Kazerooni. “And it affects funding and research dollars as well. Although lung cancer is the leading cause of cancer death in the U.S., only 6% of federal dollars dedicated to cancer research are allocated to lung cancer.”

The stigma issue is particularly harmful for the rising numbers of younger women in their 20s to 40s with no smoking history who are diagnosed with lung cancer. “When someone is forced to
emphasize that they never smoked, the message being sent to the 85% of patients with lung cancer who have a smoking history is ‘you are the ones who deserve this.’ No one deserves lung cancer,” says Jill.

Epidemiology studies centered on nonsmokers with lung cancer have begun, but actionable findings may not be reported for at least another decade or two, according to Dr. Kazerooni. The GO2 Foundation for Lung Cancer is currently studying genomic, environmental and behavioral risk factors to identify the common link among nonsmokers in order to run trials.

“We know the disease seems to be increasing among nonsmokers, especially younger women, but we don’t know enough to effectively screen for it now,” says Dr. Kazerooni.

While screening challenges remain, advances in treatment show incredible promise, especially targeted biomarker therapy, which is allowing Jill to treat her incurable lung cancer as a chronic condition.

“I never used to use the word ‘hope’ in the same sentence with lung cancer. But there is real hope now,” she says.

The following are traditional signs of non-small cell and small cell lung cancer, which can also be present as a result of many other conditions. Keep in mind, however, that the hope of expanded lung cancer screening is to find the disease before these symptoms appear.

• A cough that gets worse or does not go away
• Coughing up blood
• Breathing trouble, such as shortness of breath
• New wheezing when you breathe
• Ache or pain in your chest, upper back or shoulder that doesn’t go away and may get worse with deep breathing
• Hoarseness
• Frequent respiratory tract infections, such as pneumonia or bronchitis
• Feeling unusually tired all the time
• Weight loss with no known cause
• Trouble swallowing
• Swelling in the face and/or veins in the neck

Source: LUNGevity Foundation

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A Quick Guide to Seasonal Allergies

Pollen, Grass, Ragweed and Mold spores

For more than 24 million Americans, the flowering trees and mild weather of spring and summer, signals another allergy season in full bloom. The cause: substances such as pollen, grass, ragweed and mold spores enter the body and are mistakenly identified as a threat by the immune system, triggering a variety of symptoms. We hope you find some comfort in this quick guide to seasonal allergies.

Reduce the effects of seasonal allergies

• Pollen and spores can be carried into the home on your clothes or enter through windows during allergy season.
• Know which pollens you are sensitive to and then check pollen counts. Weather reports often include this information during allergy seasons. In spring and summer, during tree and grass pollen season, levels are highest in the evening. In late summer and early fall, during ragweed pollen season, levels are highest in the morning. For an interactive map to view allergy levels and pollen count forecasts, visit pollen.com.
• If your allergy symptoms are very bothersome:
  • Take a shower, wash your hair and change your clothes after you’ve been working or playing outdoors, and keep windows and doors shut at home and in your car.
  • Wear sunglasses and a hat outside to keep pollen out of eyes and hair. Your COVID-19 mask could provide a protective barrier against pollen.
  • Indoors, get an air purifier with a HEPA filter, and vacuum regularly.

Treatment

Seasonal allergies are often treated with over-the-counter or prescription antihistamines (non-drowsy types are available), nasal steroid sprays, decongestants and immunotherapy (allergy shots that expose you over time to gradual increments of the allergen), as well as alternative methods. Please check with your healthcare provider to discuss what’s right for you.

Symptom Checker: Is It Allergies, a Cold or COVID-19?

Not Your Imagination: Pollen Season May Be Getting Worse

According to the American College of Allergy, Asthma and Immunology (ACAAI), climate change has made pollen season longer and more severe throughout North America. A recent study showed that pollen seasons for plants like trees, grasses, and weeds showed a 20-day increase in length and a 21% increase in pollen concentration from 1990 to 2018. Notably the researchers also found that the pollen produced is more allergenic – more likely to trigger an allergic reaction with fewer grains of pollen in the air.
Sources: Mayo Clinic, ACAAI

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